Can I See That Hand?

Last night I was in the OB ward, minding my own business listening to my IPOD when a pregnant woman had the audacity to walk in.  At first I thought she was just visiting someone until I saw her bend over in what seemed to be some kind of distress and I went over to investigate.  Oh yes, she’s come to give birth.  My stomach did the drop that it always does as my adrenaline starts pumping. I asked if she’d had an operation before (hoping it would be a clear case of “take her to the OR quick quick like a bunny”…shout out Alanna!)  But alas, no previous C/S. 

She came with an older lady who was a TBA (traditional birth attendant) so since the pregnant woman was in a wee bit of pain I directed my questions to her.  “When did the belly begin hurting?”  “An hour ago.”  Huh. An hour ago?  Something didn’t make sense.  TBA’s never bring patients that quickly to the hospital unless there is some major problem.  Also, the woman seemed to be in quite a bit of pain for the labor to have just started an hour ago.  I asked the TBA what it was that made her come and she said she just wanted to get the woman checked.  Ok………

I took her back to the labor ward to check her out.  When we got there I again asked when the pain had started and this time the patient responded that it had started at about ten that morning.  OK!! That makes a little more sense!!  I started with the exam and when I got to the vaginal exam realized…something was fishy.  At first I thought it was the cord that I was feeling and had a moment of panic. Last week I lost a baby with a prolapsed cord (when the cord comes first) and it really really really sucked.  I did NOT want to do that again.  But as I started feeling around, I realized it was the hand that I was feeling.  Instead of the head being the presenting part, the hand was.  Oh boy.  Something else I’ve never seen before.  Oh, have I mentioned that OB IS NOT MY THING yet in this blog?  In case someone forgot…..there you have it. 

So the hand is presenting first.  Now what? When I did the vaginal exam I noticed a meconium stain (when the baby starts pooping inside the belly) which is a sign that the baby’s in distress.  I listened to the fetal heart tones they were 186.  Too high.  Another sign that the baby was in distress.   I knew that our doctor was in surgery so there was no way we could take her for a C-section right now anyway. I ran down to the OR to see if they were almost done. They weren’t.  Shoot. Well, I told the doc that when he was done I needed him to come down to the OB ward. 

Ok. So I can’t take her for a C/S right now.  What next?  I decided to do an ultrasound.  If the baby was breech than I was pretty confident that only a c-section would save this baby.  But if the head was down, is there any way she could push it out?  This was her fifth time giving birth so shouldn’t she be pretty well…..expanded by now?  I did the ultrasound and sure enough, the head was down.  I grabbed my book to see if I would get any inspiration there, but all I could find was how to deliver the foot first.  Blast.  Ok Emily, think.  The hand is coming first, the baby is in distress, and the woman is not fully dilated yet.  We need to get this baby out, but surgery is not an option right now. 

So what do I do until surgery is an option?  I can’t just sit and do nothing!  Ok, here’s the plan.  I’m going to augment her labor to try and get her fully dilated to see if there’s ANY way this kiddo is just going to slide right out.  After I started the drip I tried to see if there was any way I could push that hand back up there so the head would come first.  Negative Ghost Rider

Fortunately just as I started the oxytocin, the doctor showed up.  Thanks Jesus!!!  I told him about my exam, what I’d done, and my concern for the baby.  C-section it is.  Since I’d been pretty sure that’s what we were going to end up doing I’d already started all the preparations so as soon as they closed the other woman up and cleaned the OR we could take the woman right to the OR to pull this kiddo.

Because of the distress of the baby we wanted to be quick about it so instead of doing an epidural we used local anesthetic.  That’s right.  We used lidocaine to numb the incision area and cut into the woman while she was wide awake.  Don’t you want to have surgery over here!??!!  Usually they will give a medicine to knock the patient out, but in cases of c-sections they try to wait until after they’ve pulled the baby out because any medicine they give the woman will affect the baby as well.

Unfortunately this woman didn’t appreciate being cut open like a fish and started fighting.  In cases like these they take the risk and go ahead and give the sleeping medicine because if the woman starts fighting than everyone is in danger. 

As they pushed the medicine my heart sank a little because I HATE it when they have to do that (which they have to do pretty frequently......turns out most women don’t like being cut open. Weird.)  I almost always have a harder time with the baby when this happens.  Since this baby was already in distress I knew that this wouldn’t make things any easier.  Sure enough, as they pulled the baby out he wasn’t breathing.  

I took him over to the little incubator and immediately started bagging him.  I listened to his heart and it was beating, but slowly.  I knew that the medicine they give during surgery usually wears off in about 15 minutes, but the 15 minutes of waiting is FOR. EV. ER.  Also, I wasn’t sure how much of his present situation was because of the medicine and how much was because of the prolonged, stressful labor.  So I kept bagging him and slapped him around a little bit to try and make him wake up and scream at me.  Finally, his color started looking better and he started moving around a bit more.  Eventually he started breathing on his own and I just put some oxygen on him to give him a little extra help. 

All of the sudden, all the power went off in the OR.  The solar was finished.  A few months ago we got solar power for the entire hospital.  There is generally enough to do two surgeries and if we have to do more than that we run the generator.  Unfortunately this time the solar decided to cut off right in the middle of surgery.  And the surgeon was in the middle of sewing this woman up.  So what did we do?  Well obviously, myself and another guy pulled out our cell phones that have lights on them and shined the light at the woman’s incision.  After about 30 seconds of this I just started busting up laughing.  Is this really my life right now?!?!  When a fly was attracted by the light and kept trying to land on the woman’s open belly I started laughing even harder.   Fortunately my co-workers weren’t offended and we all started laughing at the absurdity of the situation.  Ten minutes later the generator came on and there was light.

Like to remember these ones!!!

My little patient wasn’t doing so great off the oxygen so I took him back down to the ward so I could keep him on the oxygen.  His right hand was extremely swollen, bluish in color and cool because the circulation had been cut off for awhile while he was in the birth canal.  However, by the time we got down to the ward he was moving all his fingers and crying a little. I think he’ll be A-OK.   It’s always an adventure………